Kids’ Access to Primary Care Act of 2025
- Bill Number
- H.R. 1433
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-02-18: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-04-23T08:07:13Z
AI-Generated Summary
Purpose
The Kids' Access to Primary Care Act of 2025 aims to improve access to primary care services for children and others enrolled in Medicaid (a joint federal-state health insurance program for low-income individuals) by renewing and expanding a policy that sets minimum payment rates for these services. This ensures providers receive payments at least equal to Medicare rates (Medicare is a federal health insurance program primarily for older adults), making it more financially viable for doctors and other providers to treat Medicaid patients.
Key Provisions
- Renewal and Expansion of Payment Floor:
- Requires states to pay for primary care services (such as routine check-ups, vaccinations, and basic treatments) at a rate of at least 100% of the Medicare rate (or the 2009 Medicare rate if higher).
- Applies to services provided starting from the first month after the bill's enactment.
- Expands eligibility to a broader range of providers, including:
- Physicians in family medicine, general internal medicine, pediatrics, or obstetrics and gynecology (OB/GYN), who must self-attest to board certification.
- Physicians in related subspecialties (e.g., pediatric cardiology or OB/GYN subspecialties).
- Advanced practice clinicians (like nurse practitioners or physician assistants) working under supervision.
- Services provided by rural health clinics, federally qualified health centers, or similar facilities.
- Independent nurse practitioners, physician assistants, or certified nurse-midwives, with payments ensuring they receive at least the Medicare-equivalent amount.
- Exclusions and Targeting:
- Primary care services do not include those provided in a hospital's emergency department to focus payments on routine, non-emergency care.
- Managed Care Requirements:
- Medicaid managed care plans (organizations that contract with states to deliver services) must pay providers the required minimum rates, including through capitation (fixed per-patient payments) or value-based arrangements (payments tied to quality outcomes), with documentation to verify compliance.
- Study and Reporting:
- The Secretary of Health and Human Services (HHS) must conduct a study within 15 months of enactment, comparing:
- Child enrollment in Medicaid before and after the new period.
- Number of providers billing for primary care services.
- State payment rates using indexes (e.g., state vs. national averages, Medicaid vs. Medicare rates, and changes over time).
- Authorizes $200,000 in funding for fiscal year 2026.
- Sense of Congress:
- Encourages providers to follow the American Academy of Pediatrics' "Bright Futures" guidelines for children's health screenings and preventive care (non-binding recommendation).
Significant Changes to Existing Law
- Extension of Temporary Policy: Previously, under the Affordable Care Act, the Medicare payment floor applied only to 2013–2015 for a limited set of primary care physicians (family medicine, general internal medicine, pediatrics). This bill renews it indefinitely starting after enactment and expands it beyond 2015.
- Broader Provider Inclusion: Adds OB/GYN, subspecialties, advanced practice clinicians, and clinic-based services, which were not covered before. It also allows self-attestation for certification instead of stricter verification.
- Managed Care Enforcement: Introduces new contract requirements for managed care plans to ensure minimum payments, including approval processes for alternative payment models, which were not explicitly mandated previously.
- Refined Definitions: Amends the definition of primary care to exclude emergency department services, targeting payments more precisely to outpatient and preventive care.
Potential Impacts
- On Government Agencies: HHS will oversee implementation, compliance verification, and the required study, potentially increasing administrative workload. States must adjust Medicaid payment systems, which could strain budgets but may qualify for federal matching funds.
- On Citizens: Low-income children and families on Medicaid may gain better access to primary care, reducing reliance on emergency rooms and improving preventive health outcomes. However, impacts depend on state adoption and provider participation.
- On International Relations: None directly, as this is a domestic health policy focused on U.S. programs.
- Broader Effects: Could increase federal Medicaid spending due to higher reimbursements but aims to lower long-term costs by promoting early care and reducing hospitalizations. The study will help evaluate effectiveness across states.
Main Stakeholders Affected
- Medicaid Enrollees: Especially children, low-income families, and pregnant women seeking primary care.
- Health Care Providers: Primary care physicians, OB/GYNs, nurse practitioners, physician assistants, certified nurse-midwives, and clinics (e.g., rural health clinics and federally qualified health centers) who treat Medicaid patients and stand to benefit from higher payments.
- State Governments: Responsible for administering Medicaid and ensuring compliance, potentially facing increased costs offset by federal funds.
- Managed Care Organizations: Must update contracts and payment processes to meet new requirements.
- Federal Government (HHS): Oversees enforcement, conducts the study, and manages funding authorizations.
Notable Legal, Constitutional, or Political Implications
- Legal: Amends Title XIX of the Social Security Act (the legal basis for Medicaid), creating enforceable requirements for state plans and managed care contracts. Includes mechanisms for HHS approval of payment arrangements, which could lead to regulatory guidance or disputes over compliance.
- Constitutional: No direct challenges anticipated, as it aligns with Congress's spending power under the Constitution to condition federal funds on state program requirements. Expansions to provider types respect state authority over health professional licensing.
- Political: Introduced with bipartisan support (sponsors from both parties), emphasizing children's health access, which could garner broad appeal. The non-binding "sense of Congress" on guidelines promotes best practices without mandating changes, avoiding potential federalism concerns. If enacted, it could influence future Medicaid reforms by demonstrating the value of payment incentives.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (11)
Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Castor, Kathy [D-FL-14], Rep. DelBene, Suzan K. [D-WA-1], Rep. Cohen, Steve [D-TN-9], Rep. Tonko, Paul [D-NY-20], Rep. Meng, Grace [D-NY-6], Rep. Sewell, Terri A. [D-AL-7], Rep. Davis, Donald G. [D-NC-1], Rep. Strickland, Marilyn [D-WA-10], Rep. Magaziner, Seth [D-RI-2], Rep. Stansbury, Melanie A. [D-NM-1]
Recent Actions
- 2025-02-18: Referred to the House Committee on Energy and Commerce.
- 2025-02-18: Introduced in House
- 2025-02-18: Introduced in House
Bill Versions
- Kids’ Access to Primary Care Act of 2025 — issued 2025-02-18 — PDF (12 pages)